Client Services Representative
4 weeks ago
The Enrollment and Credentialing Specialist plays a crucial role in ensuring that individuals and healthcare providers are properly enrolled and credentialed with insurance companies, government agencies, and other healthcare organizations. This position requires a detail-oriented individual with strong organizational and communication skills to handle the administrative tasks associated with the enrollment and credentialing processes.
Enrollments:
* Manage the enrollment process for healthcare providers, including group practices, physicians, other healthcare professionals.
* Gather and submit necessary documents, such as applications, licenses, certifications, and insurance information.
* Ensure that all enrollment forms are completed accurately and in a timely manner.
* Liaise with insurance companies, government agencies, and other healthcare organizations to facilitate the enrollment process.
* Monitor the status of enrollment applications and follow up as needed to ensure timely completion.
Credentialing:
* Coordinate the credentialing process for healthcare providers, ensuring compliance with regulatory requirements and organizational policies.
* Collect provider information, such as education, training, work history, and professional references.
* Review and analyze credentialing applications and supporting documents for accuracy and completeness.
* Communicate with providers and external organizations to obtain missing or additional information as necessary.
Database Maintenance:
* Maintain accurate and up-to-date provider enrollment and credentialing databases.
* Enter and update provider information, ensuring data integrity and confidentiality.
* Generate reports and track the status of enrollments and credentialing processes.
* Maintain accurate provider profiles for State Medicaid, CAQH, PECOS and NPPES portals
Compliance:
* Stay updated on relevant laws, regulations, and accreditation standards related to enrollment and credentialing processes.
* Ensure compliance with applicable regulatory requirements, including HIPAA and other privacy regulations.
* Assist with internal and external audits, providing necessary documentation and supporting materials.
Communication and Collaboration:
* Serve as a primary point of contact for providers regarding enrollment and credentialing inquiries.
* Collaborate with internal departments, such as Revenue Integrity and RCM leadership to gather necessary information and resolve issues.
* Build and maintain positive relationships with insurance companies, government agencies, and other external stakeholders.
Qualifications and Skills:
* High school diploma or equivalent
* Prior experience in enrollment and credentialing processes within a healthcare setting.
* Strong knowledge of healthcare industry regulations, such as HIPAA, Medicare, and Medicaid.
* Excellent attention to detail and ability to maintain accuracy while handling multiple tasks.
* Proficient computer skills, including experience with database management and Microsoft Office Suite.
* Exceptional organizational, communication, and interpersonal skills.
* Ability to work independently and as part of a team in a fast-paced environment.
* Strong problem-solving and decision-making abilities.
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